As advances in medical and surgical care enable more women with adult congenital heart disease (ACHD) to reach childbearing age, understanding pregnancy-related risks in this population has become increasingly important. However, data on maternal and neonatal outcomes remain limited.

A study published in the Journal of Gynecology, Obstetrics, and Human Reproduction conducted a multicenter retrospective cohort study across centers in Marseille, France, evaluating cardiovascular, obstetric, and neonatal outcomes among consecutive pregnancies in women with ACHD between 2015 and 2024. Outcomes were assessed throughout pregnancy, the peripartum period, and up to one year postpartum.

Findings

• The study included 129 pregnancies in 90 women with ACHD.
• Cardiovascular events occurred in 17.8% of pregnancies, with heart failure and arrhythmias each affecting 8.5% of patients.
• Despite the substantial cardiovascular risk profile, no maternal deaths were reported during pregnancy or up to one year postpartum.
• Multidisciplinary preconception counseling was documented in only 4.7% of pregnancies.
• Cardiovascular risk-guided cesarean delivery was performed in 16.3% of pregnancies, including 9.3% scheduled elective procedures.
• Neonatal complications were common, including small-for-gestational-age birth (34.9%), preterm delivery (17.8%), and intrauterine growth restriction (15.5%).

The investigators concluded that pregnancy in women with ACHD remains associated with considerable maternal cardiovascular and neonatal morbidity, even in the absence of maternal mortality.